Tobacco And Health

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Role of Health Professionals in Tobacco Control

• Manar Moneer, MD
• Maissa Kamel
• Epidemiology and Biostatistics Dept.
• NCI

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Tobacco Consumption

• The single preventable cause of morbidity and
  mortality.
• There is an estimated 1.3 billion smokers in the
  world (1/3 of the global population gt15y).
• Majority in developing countries (800 million),
• mostly men (700 million)
• By 2025, ?? 1.7 billion IF
• No dramatic changes in cessation rates,
• No new interventions
• Children start at expected rates

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The Problem

• GLOBALLY
• Tobacco kills
• ?? 1 person /6.5 seconds
• ?? 13,699 smoker/day
• ?? 5 million smoker/year
• By 2020 ?? 10 million IF
• present consumption patterns continue

70 in developing countries
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In EGYPT

• Egypt has one of highest rates of tobacco
  consumption in the Arab world.
• Smoking is an increasing public health problem
• 13 million smokers
• 20 of the population gt15 yrs
• 60 billion cigs. annually
• No. of smokers ? by 8 per year
• in 1970 ?? 12,027 million cigs.
• in 1997 ?? 51,814 million cigs.
• ? of smokers over twice as fast as the
  population growth

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In EGYPT

• WHO reports that smoking causes 90 of lung
  cancer cases in Egypt
• Smoking has a definite economic cost to Egypt.
• The direct annual cost of treating
  tobacco-related diseases in Egypt is estimated at
  
• 3 billion L.E.

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In 1997
In EGYPT
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Among Professionals
In EGYPT
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ACTIONS to be taken

• Governments and legislators have a role to play
  but they are not the only ones.
• Society at large needs to be involved in the
  struggle against tobacco.
• One group of professionals has a special role

Health Professionals
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ROLES of Health Professionals

• Role Model
• Clinician
• Educator
• Scientist
• Leader
• Opinion builder
• Alliance builder

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ROLE MODEL
Why ?

• Most knowledgeable in health matters
• Expected to act on basis of this knowledge.
• Expected to be role models for the rest of the
  population

• This includes,
• in general, their behavior in health-related
  matters such as diet and exercise, and
• particularly regarding tobacco

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The Reality

• Most people addicted tobacco before becoming a
  health-care provider.
• gt 90 of all adult smokers begin when teens, or
  earlier
• gt 1/2 become regular, daily smokers before the
  age of 19.
• Groups of health professionals may have a similar
  (if not higher) smoking prevalence than the rest
  of the population.

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The Reality

• Health professional is aware of the health
  consequences of tobacco use, more than any
  professional in a different field.
• Knowing the health hazards of tobacco is not
  enough to overcome tobacco addiction
• Using their professional and popular respect,
• they could change current smoking trends
• spread head a national antismoking movement.

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The Reality

• If THEY ARE SMOKERS
• This will create conflict
• It affects their image
• credibility as a spokesperson on tobacco
• They are less
• To promote smoking cessation
• To engage in tobacco control.

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• So, health professionals smokers need
• further support more efforts to assist them in
  becoming tobacco-free role models
• the smoking-cessation program must assist not
  only their patients but also themselves.
• Health professionals should be tobacco-free role
  models
• Peers should encourage assist one another.
• By providing supportive, non-judgmental care

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• Health professionals should know that
• Tobacco dependence is a disease
• It is not a moral issue
• Smoker is not a weak-willed person
• BUT a human being that has a health problem and
  needs treatment with a human and empathic approach

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CLINICIAN
Incorporate Cessation Counseling in your
Practice

• Assess Tobacco Use
• With vital signs monitoring.
• And at every visit
• Mark on the patient's chart
• Explain short and long term effects
• Advise quitting its benefits

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Immediate health benefits of Giving up Tobacco

• AFTER
• 20 Minutes
• BP pulse ?? to a normal rate
• Temperature of hands feet ?? to normal
• 8 Hours
• CO level in blood ?? to normal
• O2 level in blood ?? to normal
• 24 Hours
• Chance of heart attack starts ??
• 48 Hours
• Nerve endings start growing again
• Smell taste begin to improve

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Short-term health benefits of Giving up Tobacco

• 2 Weeks to 3 Months
• Circulation improves
• Walking gets easier
• Lung function improves up to 30

"It's great not have to clear my throat all the
time."
"I can talk again when I walk upstairs!"
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Short-term health benefits of Giving up Tobacco

• 1 Month to 9 Months
• ?? coughing, sinus congestion, tiredness
• shortness of breath
• Cilia (small hairs) grow back in lungs
• to better handle mucous,
• clean the lungs
• reduce infection

Im not bogged down with headaches"
"I get fewer colds and sore throats."
"I concentrate much better."
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Long-term health benefits of Giving up Tobacco

• 1 Year
• Risk of coronary artery disease is 1/2 that of a
  smoker

No more heaviness in my chest in the morning"
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Long-term health benefits of Giving up Tobacco

• 5 Years
• Lung cancer death rate ? by 1/2
• Risk of stroke as non-smoker
• Risk of cancer of mouth, throat, esophagus,
  bladder, kidney and pancreas ?.
• In addition
• Quitting can dramatically improve chronic
  illnesses (diabetes, asthma or kidney failure)

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Simple advice from a physician has been shown to
?? abstinence rates significantly (by 30)
compared to no advice.
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Nursing-led interventions for smoking cessation
increase by 50 the chances of successfully
quitting.
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Interventions that use multiple providers are
very effective
All health-care professionals can have an impact
in assisting with cessation
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Essentially, the more a person hears a
consistent message from all health
professionals, the more likely that person will
be able to quit successfully.
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You Need Not to be a Cessation Specialist

• This is a specially trained counselors, who can
  be
• physician
• nurses,
• social workers,
• psychologists
• any other health professional

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In your daily routine

• Implement the minimal intervention steps of
• ask about tobacco use,
• advise quitting
• assess willingness' to quit
• assist the patient to quit
• arrange for follow up

5 As Approach
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• Health professionals should also be
• science-based in developing disseminating
  practical materials about cessation
• adapted to the
• culture, age, language,
• health status of patient
• attitude towards quitting tobacco use.

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• Health professionals need to make
• Cessation Advice relevant to Patient's Current
  Situation
• by linking it
• with existing diagnosis
• or current lifestyle.

Relevant Advice
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• For a young patient
• smoking can cause bad breath
• it is an expensive habit
• it will mean poorer performance in sports

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• For an older patient
• the possibility of lung cancer could be more
  compelling as he has been a tobacco user for a
  longer period of time.

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• In pediatrics and maternal-child health clinics
• assess exposure to tobacco smoke
• provide information about avoiding all exposure
  (especially passive smoking).
• more important when tobacco use by the client may
  not be an issue

So, tobacco assessment advice on quitting can
be incorporated in a variety of clinical settings.
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EDUCATOR

• Preparation of new generations of health
  professionals.
• This involves
• students training (pre- post-graduate)
• bedside education
• continued education and training
• research and evaluation.

Training
Changes
Practice
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In Health Professional Curricula

• Tobacco control can be taught as
• a separate matter or
• be a part of existing content
• epidemiology,
• health promotion,
• prevention and treatment, etc..
• Training time is also an ideal opportunity to
  offer support to students who are tobacco users
  and are trying to quit.

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SCIENTIST

• Tobacco control measures must be based on
• facts
• evidence
• All health professionals should be aware of
  science-based information to implement tobacco
  control measures

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• Tobacco is a cross-cutting issue
• SO research on tobacco should be included in
  several fields
• cancer clinical trials,
• maternal-child health programs
• cardiovascular disease studies.
• For Funding Research agencies
• Create awareness and educate

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LEADER

• Health is a leadership responsibility
• Many health professionals have leadership
  positions
• Leaders are involved in policy-making process
• This leadership position can be exerted at level
• Community
• National
• Global

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• Leaders Should support comprehensive
• tobacco control
• smoke-free workplaces
• increased taxation
• increased prices of tobacco products
• campaigns to prevent youth from taking up tobacco
  
• funding for tobacco control programs
• All health professionals can take small steps to
  address at least one issue at their own workplace
  (e.g. promoting smoke-free environments)

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• Health professionals who belong
• to professional organizations can also
• influence their organization
• to become involved in tobacco control
• policy-making
• to place tobacco control in the organization's
  agenda,

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Role of Health Professional Organizations

• Encourage their members to be role models
• by not using tobacco
• by promoting a tobacco-free culture.
• Assess address the tobacco consumption patterns
  and tobacco-control attitudes of their members
  through
• surveys
• Introduction of appropriate policies.
• Make the organizations events tobacco-free
• Include tobacco control in the agenda of all
  relevant health-related congresses conferences.

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Role of Health Professional Organizations

• Advise their members to 5 As approach to their
  patients.
• Influence other health institutions educational
  centers to include tobacco control in their
  curricula, through
• continued education
• other training programs.
• Actively participate in World No Tobacco Day
  every 31 May.
• Refuse financial support from tobacco industry.

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Role of Health Professional Organizations

• Prohibit the sale or promotion of tobacco
  products on their premises
• Participate in the tobacco-control activities of
  health professional networks.
• Support campaigns for tobacco-free public places.

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OPINION-BUILDER

• This role has great potential as
• a citizen of a community
• member of an NGO
• through national associations,
• They can should express clearly the magnitude
  of the tobacco issue in terms of
• diseases
• suffering
• premature deaths
• economic burden for society

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OPINION-BUILDER

• Becoming politically active
• Writing letters to newspapers and other media,
• Issuing press releases
• Collecting signatures
• Assisting in disseminating information.
• Should be knowledgeable of existing information
  resources.

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ALLIANCE-BUILDER

• Health is important to
• all health professionals
• other groups.
• Public health is no one's domain but everyone's
  arena.
• Sometimes a health professional group should
• act by itself but
• cooperation with others should always be
  considered carefully.
• Tobacco control cut across a vast range of health
  disciplines
• To ensure that all of those, support in one way
  or another tobacco control.

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ALLIANCE-BUILDER

• Health professionals can form alliances
• as individuals,
• between societies organizations.
• The results of such alliances
• can have a much greater impact
• the benefits to tobacco control, are enhanced.

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ALLIANCE-BUILDER

• Building alliances in a vertical way is also a
  way
• to synergize efforts
• To obtain better outcomes by using existing
  resources.
• Every type of health professional association
• at the local or national level
• has its counterpart
• at the regional, international or global level.

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Recommendations to NCI

• Declare NCI as a tobacco free institute
• Smoking area should be outside NCI building
• Legislation must be enforced and applied to all
• This must be the responsibility of certain
  personnel
• Including smoking habit as a part of demographic
  data
• Smokers files should be labeled
• Health professionals should assess tobacco use
• Health professionals must be role models
• Separate entity concerning smoking in curricula
  of postgraduates
• Prevent hiring smoker employees
• Establish an antismoking clinic to help those
  trying to quit
• A committee in NCI for tobacco control, all NCI
  workers are invited to join

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